Is It Beneficial to Involve a Family Member? A Meta-Analysis of
Psychosocial Interventions for Chronic Illness
Lynn M. Martire, Amy P. Lustig, and
University of Pittsburgh
Gregory E. Miller
University of British Columbia
Vicki S. Helgeson
Carnegie Mellon University
Links between chronic illness and family relationships have led to psychosocial interventions targeted at
the patient’s closest family member or both patient and family member. The authors conducted a
meta-analytic review of randomized studies comparing these interventions with usual medical care (k ?
70), focusing on patient outcomes (depression, anxiety, relationship satisfaction, disability, and mortality)
and family member outcomes (depression, anxiety, relationship satisfaction, and caregiving burden).
Among patients, interventions had positive effects on depression when the spouse was included and, in
some cases, on mortality. Among family members, positive effects were found for caregiving burden,
depression, and anxiety; these effects were strongest for nondementing illnesses and for interventions that
targeted only the family member and that addressed relationship issues. Although statistically significant
aggregate effects were found, they were generally small in magnitude. These findings provide guidance
in developing future interventions in this area.
Key words: chronic illness, family, psychosocial interventions, meta-analysis
It is well documented that physical illness exacts a toll on the
quality of life of patients and families alike. The patient’s illness
symptoms, negative mood, and need for emotional support or
physical assistance are often taxing to close family members
(Akamatsu, Stephens, Hobfoll, & Crowther, 1992; Turk & Kerns,
1985). Family members, in turn, have a strong influence on the
patient’s psychological adjustment and management of illness,
including adherence to a treatment regimen and adoption of other
health behaviors that promote functioning and recovery (Burg &
Seeman, 1994; Lyons, Sullivan, Ritvo, & Coyne, 1995).
Awareness of the links between adult physical illness and family
relationships has led researchers to develop or modify patient-
focused psychosocial interventions to include the patient’s family,
most commonly the spouse (Keefe, Buffington, Studts, & Rumble,
2002). Similarly, psychosocial interventions have been developed
specifically for the family member on whom the patient primarily
depends for assistance and support (Schulz, O’Brien, et al., 2002;
Sorensen, Pinquart, & Duberstein, 2002). Although these two
treatment approaches have emerged from separate research litera-
tures, both are family oriented in terms of their focus on the
patient’s closest family member, either with or without patient
involvement. The purpose behind intervening with family mem-
bers varies across individual research studies within these litera-
tures. The goal may be to improve the health or well-being of the
patient, the closest family member, or both.
Despite the growing public health significance of this area, we
know little about the efficacy of treatment approaches that involve
a family member. A quantitative review is especially important in
light of the suggestion that, in some contexts, this approach may be
inappropriate or even detrimental for patients (Coyne, 1995; Dra-
cup, Guzy, Taylor, & Barry, 1986). Here we report the findings of
a cross-literature meta-analytic review of interventions involving a
family member, focusing on both patient and family member
An extensive correlational research literature provides strong
justification for targeting the patient’s closest family member
through psychosocial or behavioral interventions. Family factors
such as emotional support, intimacy, conflict, criticism, and over-
protective or solicitous behaviors have been linked with change in
Lynn M. Martire, Amy P. Lustig, and Richard Schulz, Department of
Psychiatry and University Center for Social and Urban Research, Univer-
sity of Pittsburgh; Gregory E. Miller, Department of Psychology, Univer-
sity of British Columbia, Vancouver, British Columbia, Canada; Vicki S.
Helgeson, Department of Psychology, Carnegie Mellon University.
This research was supported by National Institutes of Health Grants K01
MH065547 and P30 MH52247 and Pittsburgh Mind–Body Center Grant
P50 HL65111-65112 to the University of Pittsburgh and Carnegie Mellon
University. Gregory E. Miller was supported by an American Heart Asso-
ciation Grant in Aid, a National Alliance for Research on Schizophrenia
and Depression Young Investigator Award, and a Michael Smith Founda-
tion for Health Research Career Scholar Award. We thank Deborah J.
Jones and Daniel H. Morrow for helpful comments on earlier versions of
Correspondence concerning this article should be addressed to Lynn M.
Martire, Department of Psychiatry and University Center for Social and
Urban Research, University of Pittsburgh, 121 University Place, Room
508, Pittsburgh, PA 15260. E-mail: firstname.lastname@example.org
2004, Vol. 23, No. 6, 599–611
Copyright 2004 by the American Psychological Association
0278-6133/04/$12.00 DOI: 10.1037/0278-622.214.171.1249
a variety of patient physical and mental health outcomes, including
psychological well-being, health behaviors, pain severity, and
physical disability. These associations have been observed across
different chronic illnesses such as heart disease (see reviews by
Lyons et al., 1995; Rankin-Esquer, Deeter, & Taylor, 2000),
chronic pain (see reviews by Payne & Norfleet, 1986; Schwartz &
Ehde, 2000), rheumatic disease (see reviews by Danoff-Burg,
Ayala, & Revenson, 2000; Zautra & Manne, 1992), and cancer
(see reviews by Cooley & Moriarty, 1997; Kristjanson & Ashcroft,
1994). Much of this research has focused on the patient’s spouse,
because the spouse often has the greatest potential to affect the
patient’s health owing to the number of opportunities for support
provision and interpersonal conflict (Kiecolt-Glaser & Newton,
A significant amount of research also has demonstrated that the
patient’s close family members may experience poorer psycholog-
ical well-being, decreased relationship quality with the patient,
caregiving burden, and poorer physical health. These conse-
quences have been observed among various patient–family popu-
lations (see the reviews just cited) as well as among family
members of older adults coping with multiple impairments
(Schulz, O’Brien, Bookwala, & Fleissner, 1995; Wright, Clipp, &
George, 1993). The severity of the patient’s illness is related to
strain in family relationships and poorer family member well-
being, and illnesses involving a cognitive impairment component
appear to be especially stressful for family members (Ory, Hoff-
man, Yee, Tennstedt, & Schulz, 1999).
Previous meta-analytic reviews have shown that psychosocial
interventions aimed at ill individuals provide significant benefits
beyond the effects of usual medical care. That is, interventions
such as support groups, patient education, and cognitive–
behavioral skills training have small to medium effects on the
psychological functioning and health status of individuals with
illnesses such as cancer, heart disease, and arthritis (e.g., Dussel-
dorp, van Elderen, Maes, Meulman, & Kraaij, 1999; Hawley,
1995; Linden, Stossel, & Maurice, 1996; Meyer & Mark, 1995).
Given the bidirectional links between patient and family member
outcomes, psychosocial interventions that include the patient’s
closest family member may provide a greater benefit than medical
or psychosocial interventions focused solely on the patient in terms
of improvements in both individuals’ health and well-being.
A handful of relevant reviews have been published on this topic.
Campbell and Patterson (1995) conducted a review of family
interventions for individuals with cardiovascular disease (i.e., hy-
pertension or symptoms resulting from a myocardial infarction
[MI]) or cognitive impairment (i.e., dementia or stroke), as com-
pared with usual medical care. They concluded that involving
family members in the treatment of hypertension was more ben-
eficial than usual care in terms of lowering blood pressure, but
there was little evidence that family intervention was more bene-
ficial for individuals recovering from an MI. In their review of
findings from studies involving individuals with dementia or a
history of stroke, they concluded that caregiver interventions may
enhance the mental health of caregivers and delay nursing home
placement; in addition, they found that psychoeducational ap-
proaches were most promising. The Campbell and Patterson re-
view, although notable for adopting a broad definition of family
interventions and spanning several research literatures, was non-
quantitative and focused on only two adult illness populations.
Other reviews of the efficacy of family interventions have
focused specifically on those implemented with family members
providing care for older adults with medical frailty or dementia
(e.g., Cooke, McNally, Mulligan, Harrison, & Newman, 2001;
Pusey & Richards, 2001; Schulz, O’Brien, et al., 2002; Toseland &
Rossiter, 1989). The majority of these reviews have been descrip-
tive rather than quantitative and have focused primarily on family
member outcomes. Quantitative reviews in this area have generally
revealed small to medium effect sizes for family interventions in
terms of reduced caregiving burden and negative mood; there has
been little or no attention to patient outcomes (e.g., Acton & Kang,
2001; Knight, Lutzky, & Macofsky-Urban, 1993; Sorensen et al.,
The Current Review
In contrast to previous reports, we used meta-analysis to focus
on the benefits to patients and family members of interventions
that involved a family member and were tested with multiple
illness populations. We selected a set of outcomes that have
received much attention in correlational research and that apply to
different chronic illnesses (i.e., are not illness specific). The patient
outcomes examined in this review were depressive symptoms,
anxiety, relationship satisfaction, physical disability, and mortal-
ity. The family member outcomes examined were depressive
symptoms, anxiety, relationship satisfaction, and caregiving
We also examined four potential moderators that may specify
for whom or under what conditions an intervention involving
family is most beneficial (Baron & Kenny, 1986; Kraemer, Wil-
son, Fairburn, & Agras, 2002). First, owing to the often inalterable
course of dementia and previous research showing that psycho-
social interventions for family members of these individuals are
less effective than those for family members of other ill older
adults (Sorensen et al., 2002), we expected similar findings among
dementia patients and their family members in comparison with
other patient–family populations. Second, because the strongest
links between chronic illness and family relationships are often
found in the marital relationship (e.g., Kiecolt-Glaser & Newton,
2001; Parmelee, 1983), we expected that the largest effects in
terms of patient or family member outcomes would be observed in
family interventions focusing on spouses or couples.
Third, we expected that family interventions targeting both
patient and family member, rather than only the family member,
would have a greater impact on patient as well as family
outcomes because of their ability to reach an additional person
and to achieve synergies through this dyadic approach (Martire
& Schulz, 2001). Finally, we expected to find that family
interventions that included content addressing relationship is-
sues between patient and family member would be more ben-
eficial to both parties than interventions that focused solely on
individual issues of the patient or family member. This predic-
tion was based on the wealth of empirical research showing the
bidirectional associations between patient functioning and fam-
ily factors such as support and relationship quality (e.g., Burg &
Seeman, 1994; Turk & Kerns, 1985).
MARTIRE, LUSTIG, SCHULZ, MILLER, AND HELGESON
Identification of Studies
Our literature search was aimed at identifying published evaluations of
family psychosocial interventions, defined as nonmedical interventions
that are psychologically, socially, or behaviorally oriented and that involve
a member of an adult patient’s family or both the patient and family
member. That is, we aimed to identify interventions that were family
oriented in terms of the individual (or individuals) for whom they were
designed rather than in terms of measured outcomes. Our review did not
focus on studies testing psychosocial interventions for ill children and their
parents because the linkages between illness and family relationships are
likely to be very different in this population, adding significant heteroge-
neity to the group of studies analyzed. In addition, we focused on pub-
lished, peer-reviewed studies because we thought that they would be most
methodologically rigorous and would thus yield the strongest conclusions
in regard to treatment efficacy.
To locate studies for review, we conducted computerized literature
searches of numerous electronic databases for studies published through
October of 2002. All searches were limited to peer-reviewed, English-
language journals and studies focusing on adult populations (i.e., 18 years
of age or older). Keyword searches of the interlinked search engine OVID
included the following databases: Medline (1966–2002), PsycINFO
(1967–2002), CancerLIT (1975–2002), Cumulative Index to Nursing and
Allied Health Literature (1982–2002). We also searched the following
evidence-based medicine databases for the period 1991–2002: American
College of Physicians Journal Club, Cochrane Controlled Trials Register,
Cochrane Database of Systematic Reviews, and Database of Abstracts of
Reviews of Effectiveness. Combinations of keywords in the following
groupings were used for these OVID searches: (a) patient, ill, illness, or
health; (b) family, caregiver, caregiving, marriage, marital, spouse, spou-
sal, couple, or partner; and (c) treatment, intervention, or support.
In addition to OVID, we searched several other university-subscribed
databases across all available dates of publication: Educational Resources
Information Center (ERIC), Social Work Abstracts, Expanded Academic
ASAP, Academic Search Elite, PubMed, ISI Web of Knowledge, and Web
of Science. Also, we conducted Internet-based searches of the PsychNet
(United Kingdom), Economic and Social Research Council (United King-
dom), Inter-University Consortium for Political and Social Research, and
PDQ/NCI Publications Locator databases and the tables of contents of all
Elsevier Publications medical journals. Keyword searches of these data-
bases involved combinations of the term family, caregiving, or caregiver
and the term intervention or treatment. Next, the ancestry method of
examining references in review articles or empirical articles was used to
identify intervention studies not captured through database searching. This
was an important strategy for identifying studies, because inclusion of
family members in a psychosocial intervention was often not explicit in the
title or abstract of a journal article.
All studies were reviewed to determine whether they involved evalua-
tion of a family psychosocial intervention for a physician-diagnosed med-
ical illness (i.e., studies that evaluated psychosocial interventions for at-risk
populations such as obese individuals and smokers were excluded) and
enrolled patients and family members who were living independently in
their home(s). A pool of 235 studies was identified. All studies were
required to meet four additional criteria to be included. First, as a means of
focusing on those studies that were most methodologically rigorous, all
studies had to involve the use of a randomized, controlled design in which
participants had an equal chance of being assigned to the family interven-
tion or control condition and in which preintervention–postintervention
data were collected. Second, all of the studies had to include a comparison
of family intervention with usual patient medical care. Studies in which
family intervention was compared only with patient psychosocial interven-
tion were excluded because our search revealed that there were not enough
randomized, controlled studies to allow separate analyses addressing this
comparison (k ? 8).
Third, in the studies that targeted both patient and family member, the
number of family members enrolled had to be at least 90% of the number
of enrolled patients. We included this criterion because studies enrolling a
subgroup of family members may involve unknown selection effects as a
result of the failure to request or require participation from a family
member of each patient. Finally, all studies had to report data for patients
or family members, or both, on one or more of nine outcomes (see Table
1). These outcomes were chosen because they represented the psychosocial
and physical health indicators that were of greatest conceptual interest and
they were not disease specific; in addition, in the case of each of the
outcomes, effect sizes were available from at least two separate studies.
Of the 235 studies identified, 70 (29.8%) met the criteria for inclusion.
These studies were reported in 72 articles and are designated in the
reference list by asterisks. The primary reason that studies were excluded
was that a randomized, controlled design was not used (119 of the 165
excluded studies, or 72.1%). A number of randomized, controlled studies
also were excluded because they compared a family intervention with a
patient psychosocial intervention, an attention control condition, or another
family intervention (k ? 21, or 12.7%); they did not enroll 90% complete
Description of Outcomes Included
OutcomeDescriptionExamples of measures
Physical disability Degree of independence in carrying out basic
and instrumental ADLs
Deceased at follow-up
Barthel Index (Mahoney & Barthel, 1965); Katz ADL scale (Katz
et al., 1963)
Family member only
Caregiving burden Psychosocial or physical stress or strain
attributed to caregiving responsibilities
Burden Interview (Zarit & Zarit, 1990); Revised Memory and
Behavior Problem Checklist (Teri et al., 1992)
Patient and family member
Depressive symptomatology Feelings of depression, hopelessness, or sadness Center for Epidemiological Studies Depression Scale (Radloff,
1977); Beck Depression Inventory (Beck et al., 1961)
State-Trait Anxiety Inventory (state scale; Spielberger et al.,
1970); Brief Symptom Inventory (anxiety scale; Derogatis et
Dyadic Adjustment Scale (Spanier, 1976)
Anxiety Worry, restlessness, irritability, tension, panic,
Relationship satisfaction Degree of satisfaction in relationship with
ADL ? activities of daily living.
IS IT BENEFICIAL TO INVOLVE A FAMILY MEMBER?
patient–family member dyads (k ? 10, or 6.1%); or they did not include
one or more of the nine chosen outcomes (k ? 15, or 9.1%).
Meta-analysis is a tool for synthesizing research findings, and it pro-
ceeds in two phases. In the first phase, effect sizes are computed for each
study. An effect size represents the magnitude of the relationship between
two variables, independent of sample size. In the present context, it can be
viewed as a measure of how much a family intervention group and a usual
medical care control group differ in terms of a particular patient or family
member outcome at the end of treatment. In the second phase of meta-
analysis, effect sizes derived from individual studies are combined to arrive
at an aggregate effect size for each outcome of interest.
We calculated effect sizes from individual studies using statistics pub-
lished in the original reports. We computed Cohen’s d values by subtract-
ing the control group mean from the intervention group mean and dividing
this value by the pooled sample standard deviation.1In computing effect
sizes, we chose to focus on postintervention data from the first available
follow-up in the case of all outcomes except patient mortality. This
approach was chosen because psychosocial intervention effects for these
outcomes tend to be strongest soon after implementation and dissipate over
time. In regard to patient mortality, we computed effect sizes from the last
time point at which these data were available, because the likelihood of this
particular outcome tends to increase over time. Hence, the effect sizes
reported here should be viewed as representing the maximum benefits a
patient or family member is likely to receive from an intervention.2
The Comprehensive Meta-Analysis software program3(Borenstein &
Rothstein, 1999) was used in aggregating effect size estimates from indi-
vidual studies by means of random-effects models. Separate random-
effects models were computed for each patient and family member out-
come included in the meta-analysis. Each model yielded an aggregated
weighted effect size (d). The software program weighted each d statistic
before aggregation by multiplying its value by the inverse of its variance;
this procedure enabled larger studies to contribute to effect size estimates
to a greater extent than smaller ones.
We determined whether each aggregate effect size was statistically
significant and arose from a heterogeneous group of studies. Following
convention, aggregate effect sizes were considered statistically different
from zero when their corresponding z value was greater than 1.96 and the
95% confidence interval around them did not include zero (Rosenthal,
1991; Shadish & Haddock, 1994). To examine whether the studies con-
tributing to each aggregate effect size shared a common population value,
we computed the heterogeneity statistic Q (Shadish & Haddock, 1994),
which is chi-square distributed with k ? 1 degrees of freedom, where k
represents the number of independent effect sizes included. A statistically
significant Q value indicates that there is an extensive amount of variability
across studies that might be explained by moderating variables.
We also used meta-analysis to examine four categorical moderators of
intervention effects; we did so by conducting analyses on subgroups after
analyzing all studies for a particular outcome. The specific moderators
were illness population (dementia vs. other), family population (spouses
only vs. a mixed sample of family members), intervention target (family
member only vs. both patient and family member), and relationship focus
(yes or no). Family member involvement was defined as, at minimum,
attendance or observation during the patient’s psychosocial treatment. In
terms of the relationship focus moderator, we examined whether or not
intervention materials were described by study investigators as addressing
issues such as communication between the patient and family member, the
effects of illness on relationship quality, the effects of family behaviors or
attitudes on recovery from illness, or grief from the loss of emotional or
physical intimacy in the relationship. These issues could have been ad-
dressed with only the family member or with both members of the dyad.
Two of the authors (Lynn M. Martire and Amy P. Lustig) coded each
study for the four moderators, and discrepancies in coding were resolved
by an independent rater. Given our conceptual interest in these moderators,
we recomputed analyses not only in the presence of a statistically signif-
icant Q value but also in its absence. We were unable to examine some of
the moderators of intervention effects in cases in which fewer than two
effect sizes were available for a particular subgroup. In our description of
significant moderator findings for each outcome, we note any substantial
overlap between moderators (which would indicate that effects may not be
The average patient sample size in the studies included in our
meta-analysis was 163, and the average family member sample
size was 167. Sample sizes varied widely, however, and two
studies had particularly large samples (Jones & West, 1996, N ?
4,408; Newcomer, Yordi, DuNah, Fox, & Wilkinson, 1999, N ?
2,042). The Jones and West study involved a multisite intervention
with post-MI patients and their spouses, whereas Newcomer et al.
tested a demonstration project with Alzheimer’s disease patients
and their family members.
Excluding the two large studies, average sample sizes were 113
for patients and 87 for family members. Average ages of patients
and family members in studies that provided this information were
67.5 years (SD ? 12.5) and 59.1 years (SD ? 7.5), respectively.
The vast majority of family interventions (86%) were multicom-
ponent in nature, combining different types of psychosocial or
behavioral approaches. The most common combinations were
education with emotional support, emotional support with skills
1In cases in which descriptive statistics were not available, we com-
puted d values from inferential statistics using standard formulas
(Rosenthal, 1991). When a study failed to report statistical data but indi-
cated that there were significant differences, we computed effect sizes
assuming that p values were equivalent to .05. When a study failed to
report relevant statistics but indicated that groups did not differ with
respect to an outcome, we assumed that there was no difference between
the groups. Because there is seldom no difference between two groups, this
process represented a very conservative strategy.
2Two strategies were used to avoid violating the assumption that each
effect size for an outcome was statistically independent of other effect sizes
for that outcome (Rosenthal, 1991). First, effect sizes for studies comparing
more than one family intervention with a usual medical care control group
were obtained by calculating the average effect size across each compar-
ison of family intervention and control group. Second, for studies involving
more than one measure of an outcome (e.g., measurement of depressive
symptoms with the Center for Epidemiological Studies Depression Scale
[Radloff, 1977] and the Beck Depression Inventory [Beck, Ward, Mendel-
son, Mock, & Erbaugh, 1961]), one effect size was calculated by averaging
across the effect sizes found with each measure.
3The random-effects model views each study in a meta-analysis as a
random observation drawn from a universe of potential investigations. As
such, it assumes that the magnitude of the relationship between family
interventions and patient or family member outcomes differs across studies
as a result of random variance associated with sampling error and nonran-
dom variance that reflects important disparities between studies (Shadish &
Haddock, 1994). The latter source of variance was highly likely in the
studies included in this review because of the wide variability in illness
parameters, family populations, and methods used to deliver ostensibly
similar interventions. Random-effects models enable researchers not only
to make inferences about studies that have been done but also to generalize
to studies that might be conducted in the future (Shadish & Haddock,
MARTIRE, LUSTIG, SCHULZ, MILLER, AND HELGESON
training, and education with emotional support and skills training.
Other intervention approaches included health care planning,
structured exercise programs, and temporary transfer of patient
care to a formal care provider (e.g., adult day care). Approximately
40% of the studies reported one or more of the family member
outcomes selected for the present meta-analysis, 23% reported
selected patient outcomes, and 37% reported both patient and
family member outcomes.
Table 2 provides descriptive information for these studies ac-
cording to type of moderator. As can be seen, targeted populations
included those with illnesses that are the most common causes of
mortality in the United States (i.e., heart disease and cancer) as
well as other illnesses. The most common illness group consisted
of individuals suffering from dementia due to Alzheimer’s disease
or a related disorder; most had mild to moderate dementia. Of the
15 family interventions focusing on individuals with heart disease,
6 targeted post-MI patients, 6 targeted postsurgical or mixed
samples of patients, 2 targeted congestive heart failure patients,
and 1 targeted individuals with essential hypertension. Studies also
targeted frail older adults who suffered from one or more chronic
illnesses or conditions such as osteoarthritis, pulmonary disease,
and Parkinson’s disease. The 5 cancer studies targeted breast
cancer (2 studies), lung cancer (1 study), and a mixed sample of
cancer patients (2 studies).
Table 2 also shows that most family interventions focused on a
mixture of family members such as the spouse, an adult son or
daughter, and a sibling. The majority of studies (54%) were
described as targeting both patient and family member. Despite the
fact that the links between illness and interpersonal functioning in
the family often serve as the rationale for family interventions,
only a slight majority of studies were described by investigators as
addressing issues that may have been important in the relationship
between the patient and family member.
Meta-analytic results for the five patient outcomes and four
family outcomes are presented in Tables 3 and 4, respectively.
Values in the first column of these tables refer to the number of
studies (k) available for the computation of a specific effect size;
k values ranged from 5 to 41 in our analyses. The second column
provides the sample size on which the effect size was based. The
third column shows the aggregate effect size d. Effect sizes of .20,
.50, and .80 correspond to small, medium, and large effects,
respectively (Cohen & Cohen, 1983). Positive d values indicate
that family intervention was associated with greater improvement
on a particular outcome than was usual medical care.
Patient Outcomes and Moderator Findings
The meta-analysis yielded little evidence that family interven-
tions reliably ameliorated patients’ depressive symptoms in com-
parison with usual medical care (d ? .14, p ? .11, k ? 27).
However, there was substantial variability among this group of
studies as indicated by the Q statistic. Our stratified analyses of the
four moderator variables indicated that, as predicted, family inter-
ventions including only spouses were successful in reducing pa-
tients’ depressive symptoms (d ? .33, p ? .04, k ? 13; see Table
3). There was a significant amount of variability in outcomes
among these 13 studies. As we predicted, interventions involving
other family members, such as mixed groups of adult children and
spouses, did not produce reliable changes in patients’ depressive
symptoms (see Table 3). The difference between these subgroup
effect sizes was statistically significant according to Fisher’s z test
(p ? .001).
The meta-analysis provided little evidence that family interven-
tions reliably ameliorated patients’ anxiety (d ? .09, p ? .29, k ?
13) or enhanced patients’ satisfaction in their relationship with the
family member included (d ? .37, p ? .10, k ? 5; Table 3). The
medium aggregate effect size for relationship satisfaction was
mainly due to a large effect found in one of the five studies in this
category (Bultz, Speca, Brasher, Geggie, & Page, 2000). Although
the effect sizes for patient anxiety and relationship satisfaction
were statistically nonsignificant, Q statistics indicated that there
was a significant amount of variability in outcomes among the
studies assessing these constructs. In the case of patient anxiety,
we were able to examine whether effect sizes differed according to
all potential moderating variables other than illness population.
There was no evidence that family interventions reduced anxiety
within any of these subsets of studies. In the case of relationship
satisfaction, there was an adequate number of studies to stratify by
intervention target and by family relationship. However, we found
no evidence that interventions differentially influenced relation-
ship satisfaction within these categories.
There was no evidence that family interventions had a reliable
influence in terms of the physical disability of patients. Neither the
aggregate effect size (d ? .04, p ? .39, k ? 9) nor the Q test was
statistically significant, and when follow-up analyses were strati-
fied by the moderator variables, there were still no reliable effects.
These findings indicate that family interventions do not reduce
physical disability any better than usual medical care under many
of the conditions examined in the randomized studies included in
In contrast, there was a marginally significant effect of family
interventions on patient mortality (d ? .08, p ? .06, k ? 9; Table
3). The studies responsible for this effect were heterogeneous, and
further analyses indicated that, as predicted, family interventions
did not reliably decrease mortality among dementia patients but
Description of Studies Included (N ? 70), by Moderator
Dementia due to ADRD
Frail older adults
Traumatic brain injury
Mixed family members
Targets of intervention
Family member only
Patient and family member
Focus on relationship issues
ADRD ? Alzheimer’s disease or a related disorder.
IS IT BENEFICIAL TO INVOLVE A FAMILY MEMBER?
decreased mortality among individuals with other types of ill-
nesses (d ? .13, p ? .05, k ? 5), an effect with a confidence
interval that included zero.4The difference between subgroup
effect sizes was statistically significant (p ? .001). All five studies
in the nondementia category focused on individuals with heart
disease (i.e., post-MI, hypertension, and congestive heart failure
patients), and follow-up time points ranged from 90 days to 5
Contrary to prediction, family interventions reliably decreased
mortality when they involved a mixed group of family members
(d ? .14, p ? .02, k ? 6). To get a sense of the practical
importance of this finding, we translated it into a binomial effect
size display (Rosenthal, 1991). Doing so revealed that whereas
53.5% of the patients who received a family intervention could
expect to be living at the end of follow-up, only 46.5% of those in
usual care could. Family interventions were not successful in
decreasing patient mortality when they involved only spouses (see
Table 3), and the difference between these subgroup effect sizes
was statistically significant (p ? .001).
The stratified analyses also showed that the likelihood of patient
mortality was significantly reduced by family interventions that
did not address relationship issues (d ? .13, p ? .01, k ? 7). This
beneficial effect, which indicates that 53% of patients were living
at follow-up versus 47% of those in usual care, was not expected.
Studies that included a focus on relationship issues did not reliably
decrease mortality, and the difference between the subgroup effect
sizes was statistically significant (p ? .001). The nonsignificant Q
statistic for these analyses suggests that effects were uniform
across studies. The moderator findings for patient mortality should
be interpreted cautiously because they were based on a very small
number of studies (i.e., only three studies included spouses, and
only two focused on relationship issues). In addition, in this
particular group of studies there was much overlap between two of
the moderators, type of family member included and relationship
focus; that is, six of the seven studies that did not address rela-
tionship issues focused on mixed family member groups.
Family Member Outcomes and Moderator Findings
Table 4 displays the meta-analytic results for the four family
member outcomes examined. There was evidence that family
interventions are successful in reducing depressive symptomatol-
ogy among family members (d ? .10, p ? .02, k ? 41). The Q
statistic indicated that this large group of studies was heteroge-
neous in terms of outcomes.
Further analyses indicated significant effects for all four mod-
erators. First, as predicted, family interventions reduced depressive
symptoms in family members when they focused on illnesses other
than dementia (d ? .17, p ? .03, k ? 18), whereas family members
of dementia patients did not show fewer postintervention depres-
sive symptoms (see Table 4). Second, contrary to prediction,
family interventions were beneficial for mixed groups of family
members (d ? .10, p ? .04, k ? 29) but not for groups consisting
of only spouses. Third, interventions targeted only at the family
member were successful in reducing family member depressive
symptoms (d ? .15, p ? .01, k ? 24), whereas interventions
targeted at both patient and family member did not show this
effect, contrary to prediction.
4Excluding the study of Jones and West (1996; N ? 4,408), the
aggregate effect size for patient mortality was significant (d ? .11, p ? .01,
95% confidence interval ? .02, .20), and the effect size for the nondemen-
tia subgroup was .21 (p ? .00, 95% confidence interval ? .08, .34).
However, it is important to note that this large study did not obtain the
same effect as smaller studies (d ? .00). No other findings differed when
this study and the study of Newcomer et al. (1999; N ? 2,042) were
excluded from the meta-analysis.
Meta-Analysis of Patient Outcomes With Moderator Findings
effect size d
Mixed family members
Mixed family members
on each outcome that yielded a significant or marginally significant aggregate d. CI ? confidence interval;
Spouses/mixed family members ? family interventions involving spouses only versus adult children or a mixed
group of family members (e.g., spouses and adult children); Dementia/nondementia ? family interventions
focused on dementia versus other illnesses; Relationship focused/non–relationship focused ? family interven-
tions that did or did not address relationship issues between patient and family member.
†† p ? .06.* p ? .05. *** p ? .001.
Data are presented for the analyses conducted for the five patient outcomes and for the subgroup analyses
MARTIRE, LUSTIG, SCHULZ, MILLER, AND HELGESON
Finally, family members became less depressed as a result of
interventions that included a relationship focus, as predicted (d ?
.16, p ? .01, k ? 22), but did not show this benefit when
relationship issues were not addressed. The differences between
subgroup effect sizes were statistically significant (p ? .001) in all
cases other than the effects for spouses versus mixed family
members. The significant subgroup effects were heterogeneous
with the exception of the effect for relationship-focused studies. It
should be noted that there was an extensive amount of overlap
between moderators in this group of studies, in that 12 of the 18
studies involving patients without dementia included a relationship
focus and 17 of the 24 studies targeting only the family member
enrolled mixed family member groups.
There was no evidence that psychosocial interventions relieved
anxiety among family members (d ? .14, ns, k ? 14), and this null
effect was uniform across studies, as indicated by the nonsignifi-
cant heterogeneity statistic. Stratified analyses revealed significant
effects for one of the moderators. Interventions that addressed
relationship issues reduced family members’ anxiety (d ? .21, p ?
.05, k ? 9), as predicted, whereas interventions that did not address
these issues did not benefit family members in this regard. The
difference between subgroup effect sizes was statistically signifi-
cant (p ? .01). The meta-analysis provided little evidence that
family interventions reliably enhanced the satisfaction of family
members in their relationship with the patient (d ? ?.08, ns, k ?
6), and this null effect was uniform across the six studies (Table 4).
There was an adequate number of studies to stratify by illness
population; however, we found no evidence that interventions
differentially influenced relationship satisfaction within this
The strongest evidence for the efficacy of family interventions
was found for the outcome of family burden (d ? .10, p ? .00, k ?
40) and represented a small difference in scores on a posttreatment
burden measure between groups that did and did not receive a
family intervention. Although this aggregate effect size was small,
it was uniform across studies, as indicated by the Q statistic. As
shown in Table 4, stratified analyses revealed significant and
homogeneous effects for all moderator subgroups. Family inter-
ventions reliably reduced the caregiving burden of family mem-
bers of dementia patients (d ? .10, p ? .00, k ? 25) as well as
family members of other types of patients (d ? .20, p ? .00, k ?
15). In addition, family interventions reliably reduced family bur-
den in spousal groups (d ? .26, p ? .00, k ? 7) and reduced family
burden in mixed groups of family members (d ? .09, p ? .00,
k ? 33).
Family interventions that targeted both family member and
patient were successful in reducing family burden (d ? .11, p ?
.01, k ? 16), but family interventions that targeted only the family
Meta-Analysis of Family Member Outcomes With Moderator Findings
effect size d
Mixed family members
Family member as target
Patient and family member
Mixed family members
Family member as target
Patient and family member
on each outcome that yielded a significant, or marginally significant, aggregate d. CI ? confidence interval.
Dementia/nondementia ? family interventions focused on dementia versus other illnesses; Spouses/mixed
family members ? family interventions involving spouses only versus adult children or a mixed group of family
members (e.g., spouses and adult children); Family member as target/patient and family member as targets ?
family interventions that targeted only the family member versus both the patient and family member;
Relationship focused/non–relationship focused ? family interventions that did or did not address relationship
issues between patient and family member.
† p ? .07.* p ? .05. ** p ? .01. *** p ? .001.
Data are presented for the analyses conducted for the four family outcomes and for subgroup analyses
IS IT BENEFICIAL TO INVOLVE A FAMILY MEMBER?
member were also successful (d ? .17, p ? .00, k ? 24). Finally,
family interventions reliably reduced family burden when their
content addressed relationship issues between patients and family
members (d ? .22, p ? .00, k ? 18) but were also beneficial when
they did not address these issues (d ? .07, p ? .01, k ? 22). The
magnitudes of the aggregate effects for the various subgroups were
consistent with our predictions, with the exception of the effects
found for intervention target. The differences between subgroup
effect sizes were statistically significant in all cases (p ? .01). In
terms of moderator overlap, 19 of the 24 studies targeting only the
family member enrolled mixed family member groups.
Targeting family members of chronically ill individuals through
psychosocial or behavioral strategies is a logical treatment ap-
proach that is gaining increased research attention. The main
objective of this review was to take a broad first step toward
evaluating the efficacy of psychosocial interventions involving a
family member. We found that randomized, controlled studies
comparing family interventions and usual medical care focused on
those physical illnesses that are likely to have an especially potent
effect on close family members because they require physical
assistance with daily activities or supervision over extended peri-
ods of time (e.g., dementia or stroke), are life threatening (e.g.,
cancer), or are painful (e.g., chronic pain and rheumatoid arthritis).
In addition, interventions were often focused on illnesses that have
a trajectory strongly influenced by lifestyle changes (e.g., heart
disease) and thus are likely to be strongly influenced by the
attitudes and behaviors of family members.
Overall, our analyses showed the strongest evidence of efficacy
in the case of family members. Interventions appeared to result in
the patient’s closest family member feeling less depressed and
burdened; also, they reduced anxiety when they included a focus
on relationship issues between the patient and family member. The
depression effect translated into a small difference in scores on a
posttreatment depression inventory between groups that did and
did not receive a family intervention. Although this effect may
seem small by clinical standards, it is roughly equal to the reduc-
tion in emotional distress seen in studies of psychological inter-
ventions with cardiac patients (Dusseldorp et al., 1999). The find-
ings in regard to family members’ depressive symptoms and
burden may have important implications for physical health, in that
improvements in these factors are likely to reduce the greater risk
for mortality that has been demonstrated in family members
(Schulz & Beach, 1999).
The findings of our moderator analyses focusing on depressive
symptoms were consistent with the observation of other research-
ers that family members of individuals with dementia are faced
with increasingly uncontrollable stressors over time, and it may be
especially difficult to improve their mental health through psycho-
social interventions in the face of such countervailing forces (e.g.,
Haley, Brown, & Levine, 1987; Sorensen et al., 2002). Interven-
tions that focused on the relationship between patient and family
member appeared to be most effective in reducing family member
depression. Unexpectedly, interventions that targeted only family
members and included mixed groups of such individuals were also
effective. It is likely that these subsets of studies included inter-
ventions that were intensely focused on the emotional needs of the
family member. The results of our moderator analyses focusing on
the outcome of burden showed that family interventions were
beneficial across all subgroups, and the differences in subgroup
effects were almost entirely consistent with our predictions. Our
analyses showed no evidence that interventions enhanced the
family member’s satisfaction in his or her relationship with the
Family interventions appeared to achieve reductions in patient
depression only when they focused on spouses or couples. The
greater proximity and intimacy of couples, as well as the emotional
contagion from one spouse to the other (Bookwala & Schulz,
1996; Tower & Kasl, 1996), probably explain this predicted effect.
This translates into a small-to-medium-sized difference in post-
treatment depressive symptoms between patients who did and did
not receive a family intervention. Reduced patient depressive
symptomatology may have positive implications for physical
health owing to the link between depression and the onset or
exacerbation of diseases such as coronary artery disease, cancer,
and diabetes (Glassman & Shapiro, 1998; Penninx et al., 1998;
Schulz, Draper, & Rollman, 2002).
We also found evidence that family interventions enhanced
patient survival but in ways that were only partially consistent with
our hypotheses. As expected, reduced mortality was found among
individuals coping with an illness other than dementia (in this
group of studies, heart disease). Unexpectedly, family interven-
tions reduced patient mortality if they included mixed groups of
family members and did not address relationship issues. The focus
on high-risk cardiac populations in these studies may explain the
ability of interventions to affect mortality. We found no meta-
analytic evidence that family interventions reduced patient anxiety,
relationship satisfaction, or disability. Importantly, neither the
significant nor the nonsignificant effects observed among patients
were dependent on whether or not patients were included in the
The present meta-analytic findings raise the issue of potential
social or behavioral mechanisms of family intervention effects. We
found that family interventions reduced patients’ depressive symp-
toms when they focused on both patients and their spouses. It is
possible that spouses in these studies became more supportive or
less critical of the patient (Manne, 1999; Martire, Stephens,
Druley, & Wojno, 2002) and that spouses’ participation in the
intervention was considered by the patient to be an act of support.
We also found that, under certain conditions, family interventions
reduced the likelihood of mortality among individuals with heart
disease, possibly through behavioral pathways such as improved
diet, exercise, and general vigilance regarding health. Unfortu-
nately, change in family support indicators or patient health be-
haviors is rarely assessed within interventions involving a family
In summary, family intervention appears to be a promising
psychosocial approach that is not associated with negative out-
comes for either the patient or the family member. The aggregate
effects that we found for patients and family members were small
in magnitude but consistent with those found with other psycho-
social approaches to treating chronic illness. This intervention
approach is a logical one because close family or friends represent
the preferred source of support for many people, as well as the
source of support exhibiting the most impact (Cutrona & Cole,
2000). Moreover, given the current health care trend in shifting
MARTIRE, LUSTIG, SCHULZ, MILLER, AND HELGESON
patient care to families, further development and evaluation of
psychosocial interventions that incorporate family members may
be useful from a broader, public health perspective.
Limitations of Our Review
It is important to acknowledge several limitations of this review.
First, our meta-analysis did not include unpublished studies. Our
focus was on published, peer-reviewed studies, because we
thought that they would be most methodologically rigorous and
thus yield the strongest conclusions in regard to treatment efficacy.
Second, our analyses did not take into account that population
effect sizes may be overestimated owing to a tendency for null
findings to not appear in the published literature. We did not make
statistical corrections for publication bias, because these correc-
tions are often overly conservative when a small number of studies
are aggregated, as was true for many of our outcomes. Because of
these decisions, our meta-analytic findings should be considered
preliminary and in need of corroboration. In addition, our inclusion
of different illnesses, family populations, and types of psychoso-
cial interventions resulted in a very heterogeneous group of stud-
ies, as would be expected, and necessitated that we constrain our
review to mental and physical health indicators that were gener-
alizable across illnesses.
Directions for Future Research
We recommend that researchers focusing on specific illness
populations review the evidence regarding the feasibility and ef-
ficacy of interventions involving a family member in their area of
research, particularly in terms of illness-specific patient outcomes
such as cardiac symptoms, pain severity, cancer recurrence, and
pulmonary function. Relatedly, there is much room for testing
family interventions involving illnesses that have received little or
no attention in this regard, such as painful conditions (e.g., chronic
headaches and fibromyalgia), respiratory disorders (e.g., asthma
and chronic obstructive pulmonary disease), and other illnesses
that have been shown to affect and be affected by family members
(e.g., diabetes and Crohn’s disease). In addition, our literature
search revealed that there is clearly a need for randomized, con-
trolled studies comparing interventions involving family members
and patient-focused interventions. In all future work in this area, it
would be optimal to assess both patient and family member out-
comes to determine efficacy from the perspective of the dyad (i.e.,
benefits for both individuals or neither individual or benefits for
one individual with no change in the other). Because our focus was
on intervention effects observed at the first follow-up, future
research should be aimed at evaluating the long-term or lagged
effects of interventions involving family members.
Mirroring the broader psychosocial intervention literature, we
found that the majority of family intervention studies failed to
describe how theory was used in the development of intervention
materials and in the choice of measured outcomes. In studies in
which a family member was incorporated into the patient’s psy-
chosocial intervention, it was also often unclear why the investi-
gators chose to involve the family member. Rather, we found that
it was most common for authors to simply cite one or two studies
showing that family members affect the patient’s functioning and
adherence or are highly burdened by the patient’s illness. If this
area of research is to advance, investigators should reference the
particular conceptual models used in their choice of research
design and intervention materials (e.g., marital or family systems
frameworks or family caregiving models) and indicate how their
findings inform such models.
We also found that it was uncommon for studies to report the
extent to which patients or family members fully participated in a
family intervention (e.g., number of sessions attended). This made
it difficult to ascertain whether or not any null intervention effects
were due to participants not receiving the intended information or
materials (i.e., deficits in treatment receipt; see Lichstein, Riedel,
& Grieve, 1994). Such information also speaks to the feasibility of
family interventions and would be highly valuable to researchers
in this area.
Because of the heterogeneity of the studies included in our
meta-analysis, we took a relatively simplistic approach to se-
lecting variables to examine as potential moderators of inter-
vention effects. Additional moderators to examine in future
research include gender and relationship satisfaction of the
patient and family member, along with patient physical comor-
bidities and dependency, health of the family member, and
perceived support of the patient and family member. These
individual-level variables have not been examined as modera-
tors in family intervention research to date. Patients and family
members with specific characteristics may be appropriate for
family interventions, whereas others may be better served by
efforts to enhance patients’ social support from sources outside
of the family (Helgeson, Cohen, Schulz, & Yasko, 2000).
Further attention to moderators in family intervention research
would inform the development of the next generation of studies
and also determine the appropriateness of conducting needs
assessments among patients and family members.
As mentioned previously, another important objective of future
research in this area is to identify the mechanisms by which
specific types of family interventions may benefit the mental and
physical health of patients and family members. Possible mecha-
nisms for such health effects include improved self-efficacy, self-
esteem, health behaviors, and relationship quality, as well as
reduced burden for the family member and enhanced family sup-
port for the patient. In the future, it will be important for interven-
tion studies to be designed to test such mediational effects (Krae-
mer et al., 2002).
References marked with an asterisk indicate studies included in the
Acton, G. J., & Kang, J. (2001). Interventions to reduce the burden of
caregiving for an adult with dementia: A meta-analysis. Research in
Nursing and Health, 24, 349–360.
Akamatsu, T. J., Stephens, M. A. P., Hobfoll, S. E., & Crowther,
J. H. (Eds.). (1992). Family health psychology. Washington, DC:
Baron, R. M., & Kenny, D. A. (1986). The mediator-moderator variable
distinction in social psychological research: Conceptual, statistical, and
strategic considerations. Journal of Personality and Social Psychology,
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961).
An inventory for measuring depression. Archives of General Psychiatry,
IS IT BENEFICIAL TO INVOLVE A FAMILY MEMBER?
*Bengtsson, K. (1983). Rehabilitation after myocardial infarction: A con-
trolled study. Scandinavian Journal of Rehabilitative Medicine, 15, 1–9.
Bookwala, J., & Schulz, R. (1996). Spousal similarity in subjective well-
being: The Cardiovascular Health Study. Psychology and Aging, 11,
Borenstein, M., & Rothstein, H. (1999). Comprehensive meta-analysis: A
computer program for research synthesis. Englewood Cliffs, NJ:
*Bourgeois, M. S., Schulz, R., Burgio, L. D., & Beach, S. (2002). Skills
training for spouses of patients with Alzheimer’s disease: Outcomes
of an intervention study. Journal of Clinical Geropsychology, 8,
*Bradley, L. A., Young, L. D., Anderson, K. O., Turner, R. A., Agudelo,
C. A., McDaniel, L. K., et al. (1987). Effects of psychological therapy on
pain behavior of rheumatoid arthritis patients. Arthritis and Rheumatism,
*Brennan, P. F., Moore, S. M., & Smyth, K. A. (1995). The effects of a
special computer network on caregivers of persons with Alzheimer’s
disease. Nursing Research, 44, 166–172.
*Bultz, B. D., Speca, M., Brasher, P. M., Geggie, P. H. S., & Page, S. A.
(2000). A randomized controlled trial of a brief psychoeducational
support group for partners of early stage breast cancer patients. Psycho-
Oncology, 9, 303–313.
Burg, M. M., & Seeman, T. E. (1994). Families and health: The negative
side of social ties. Annals of Behavioral Medicine, 16, 109–115.
*Burgener, S. C., Bakas, R., Murray, C., Dunahee, J., & Tossey, S. (1998).
Effective caregiving approaches for patients with Alzheimer’s disease.
Geriatric Nursing, 19, 121–126.
*Burgess, A. W., Lerner, D. J., D’Agostino, R. B., Vokonas, P. S.,
Hartman, C. R., & Gaccione, P. (1987). A randomized control trial of
cardiac rehabilitation. Social Science and Medicine, 24, 359–370.
Campbell, T. L., & Patterson, J. M. (1995). The effectiveness of family
interventions in the treatment of physical illness. Journal of Marriage
and Family Therapy, 21, 545–584.
*Carnevale, G. J., Anselmi, V., Busichio, K., & Millis, S. R. (2002).
Changes in ratings of caregiver burden following a community-based
behavior management program for persons with traumatic brain injury.
Journal of Head Trauma Rehabilitation, 17, 83–100.
*Christensen, D. N. (1983). Postmastectomy couple counseling: An out-
come study of a structured treatment protocol. Journal of Sex and
Marital Therapy, 9, 266–275.
*Chu, P., Edwards, J., Levin, R., & Thomson, J. (2000). The use of clinical
case management for early stage Alzheimer’s patients and their families.
American Journal of Alzheimer’s Disease and Other Dementias, 15,
Cohen, J., & Cohen, P. (1983). Applied multiple regression/correlation
analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum.
Cooke, D. D., McNally, L., Mulligan, K. T., Harrison, M. J. G., &
Newman, S. P. (2001). Psychosocial interventions for caregivers of
people with dementia: A systematic review. Aging and Mental Health, 5,
Cooley, M. E., & Moriarty, H. J. (1997). An analysis of empirical studies
examining the impact of the cancer diagnosis and treatment of an adult
on family functioning. Journal of Family Nursing, 3, 318–347.
Coyne, J. C. (1995). Intervention in close relationships to improve coping
with illness. In R. F. Lyons, M. J. L. Sullivan, P. G. Ritvo, & J. C. Coyne
(Eds.), Relationships in chronic illness and disability (pp. 96–122).
Thousand Oaks, CA: Sage.
Cutrona, C. E., & Cole, V. (2000). Optimizing support in the natural
network. In S. Cohen, L. G. Underwood, & B. H. Gottlieb (Eds.), Social
support measurement and intervention: A guide for health and social
scientists (pp. 278–310). Oxford, England: Oxford University Press.
Danoff-Burg, S., Ayala, J., & Revenson, T. A. (2000). Researcher knows
best? Toward a closer match between the concept and measurement of
coping. Journal of Health Psychology, 5, 183–194.
*Dellasega, C., & Zerbe, T. M. (2002). Caregivers of frail rural older
adults: Effects of an advanced practice nursing intervention. Journal of
Gerontological Nursing, 28(10), 40–49.
Derogatis, L. R., Yevzeroff, H., & Wittelsberger, B. (1975). Social class,
psychological disorder, and the nature of the psychopathologic indicator.
Journal of Consulting and Clinical Psychology, 43, 183–191.
*Doerr, B. C., & Jones, J. W. (1979). Effect of family preparation on
the state anxiety level of the CCU patient. Nursing Research, 28,
*Dracup, K., Guzy, P. M., Taylor, S. E., & Barry, J. (1986). Cardiopul-
monary resuscitation (CPR) training: Consequences for family members
of high-risk cardiac patients. Archives of Internal Medicine, 146, 1757–
*Dracup, K., Moser, D. K., Taylor, S. E., & Guzy, P. M. (1997). The
psychological consequences of cardiopulmonary resuscitation training
for family members of patients at risk for sudden death. American
Journal of Public Health, 87, 1434–1439.
Dusseldorp, E., van Elderen, T., Maes, S., Meulman, J., & Kraaij, V.
(1999). A meta-analysis of psychoeducational programs for coronary
heart disease patients. Health Psychology, 18, 506–519.
*Fridlund, B., Hogstedt, B., Lidell, E., & Larsson, P. A. (1991). Recovery
after myocardial infarction: Effects of a caring rehabilitation pro-
gramme. Scandinavian Journal of Caring Science, 5, 23–32.
*Fung, W., & Chien, W. (2002). The effectiveness of a mutual support
group for family caregivers of a relative with dementia. Archives of
Psychiatric Nursing, 26, 134–144.
*Gallagher-Thompson, D., Lovett, S., Rose, J., McKibbin, C., Coon, D.,
Futterman, A., et al. (2000). Impact of psychoeducational interventions
on distressed family caregivers. Journal of Clinical Geropsychology, 6,
*Gitlin, L. N., Belle, S. H., Burgio, L., Czaja, S., Mahoney, D., Gallagher-
Thompson, D., et al. (2003). Effect of multi-component interventions on
caregiver burden and depression: The REACH multi-site initiative at 6
months follow-up. Psychology and Aging, 18, 361–374.
*Gitlin, L. N., Corcoran, M., Winter, L., Boyce, A., & Hauck, W. W.
(2001). A randomized, controlled trial of a home environmental inter-
vention: Effect on efficacy and upset in caregivers and on daily function
of persons with dementia. Gerontologist, 41, 4–14.
Glassman, A. H., & Shapiro, P. A. (1998). Depression and the course of
coronary artery disease. American Journal of Psychiatry, 155, 4–11.
*Goldberg, R. J., & Wool, M. S. (1985). Psychotherapy for the spouses of
lung cancer patients: Assessment of an intervention. Psychotherapy and
Psychosomatics, 43, 141–150.
*Grant, J. S., Elliott, T. R., Weaver, M., Bartolucci, A. A., & Giger, J. N.
(2002). Telephone intervention with family caregivers of stroke survi-
vors after rehabilitation. Stroke, 33, 2060–2065.
*Haley, W. E., Brown, L., & Levine, E. G. (1987). Experimental evalua-
tion of the effectiveness of group intervention for dementia caregivers.
Gerontologist, 27, 376–382.
Hawley, D. J. (1995). Psycho-educational interventions in the treatment of
arthritis. Baillieres Clinical Rheumatology, 9, 803–823.
*Hebert, R., Leclerc, G., Bravo, G., Girouard, D., & Lefrancois, R. (1994).
Efficacy of a support group programme for caregivers of demented
patients in the community: A randomized controlled trial. Archives of
Gerontology and Geriatrics, 18, 1–13.
Helgeson, V. S., Cohen, S., Schulz, R., & Yasko, J. (2000). Group support
interventions for women with breast cancer: Who benefits from what?
Health Psychology, 19, 101–114.
*Hepburn, K. W., Tornatore, J., Center, B., & Ostwald, S. W. (2001).
Dementia family caregiver training: Affecting beliefs about caregiving
and caregiver outcomes. Journal of the American Geriatrics Society, 49,
MARTIRE, LUSTIG, SCHULZ, MILLER, AND HELGESON
*Horlick, L., Cameron, R., Firor, W., Bhalerao, U., & Baltzan, R.
(1984). The effects of education and group discussion in the post
myocardial infarction patient. Journal of Psychosomatic Research,
*Hughes, S. L., Cummings, J., Weaver, F., Manheim, L. M., Conrad,
K. J., & Nash, K. (1990). A randomized trial of Veterans Adminis-
tration home care for severely disabled veterans. Medical Care, 28,
*Jones, D. A., & West, R. R. (1996). Psychological rehabilitation after
myocardial infarction: Multicentre randomised controlled trial. British
Medical Journal, 313, 1517–1521.
Katz, S., Ford, A. B., Moskowitz, R. W., Jackson, B. A., & Jeffee, M. W.
(1963). Studies of illness in the aged: The index of ADL: A standardized
measure of biological and psychosocial function. Journal of the Amer-
ican Medical Association, 185, 914–919.
Keefe, F. J., Buffington, A. L. H., Studts, J. L., & Rumble, M. E. (2002).
Behavioral medicine: 2002 and beyond. Journal of Consulting and
Clinical Psychology, 70, 852–856.
Kiecolt-Glaser, J. K., & Newton, T. L. (2001). Marriage and health: His
and hers. Psychological Bulletin, 127, 472–503.
Knight, B. G., Lutzky, S. M., & Macofsky-Urban, F. (1993). A meta-
analytic review of interventions for caregiver distress: Recommenda-
tions for future research. Gerontologist, 33, 240–248.
*Kozachik, S. L., Given, C. W., Given, B. A., Pierce, S. J., Azzouz, F.,
Rawl, S. M., et al. (2001). Improving depressive symptoms among
caregivers of patients with cancer: Results of a randomized clinical trial.
Oncology Nursing Forum, 28, 1149–1157.
Kraemer, H. C., Wilson, G. T., Fairburn, C. G., & Agras, W. S. (2002).
Mediators and moderators of treatment effects in randomized clinical
trials. Archives of General Psychiatry, 59, 877–883.
Kristjanson, L. J., & Ashcroft, T. (1994). The family’s cancer journey: A
literature review. Cancer Nursing, 17, 1–17.
*Lawton, M. P., Brody, E. M., & Saperstein, A. R. (1989). A controlled
study of respite service for caregivers of Alzheimer’s patients. Geron-
tologist, 29, 8–16.
*Lenz, E. R., & Perkins, S. (2000). Coronary artery bypass graft surgery
patients and their family member caregivers: Outcomes of a family-
focused staged psychoeducational intervention. Applied Nursing Re-
search, 13, 142–150.
Lichstein, K. L., Riedel, B. W., & Grieve, R. (1994). Fair tests of clinical
trials: A treatment implementation model. Advances in Behavioral Re-
search and Therapy, 16, 1–29.
Linden, W., Stossel, C., & Maurice, J. (1996). Psychosocial interventions
for patients with coronary artery disease: A meta-analysis. Archives of
Internal Medicine, 156, 745–752.
*Logiudice, D., Waltrowicz, W., Brown, K., Burrows, C., Ames, D., &
Flicker, L. (1999). Do memory clinics improve the quality of life of
carers? A randomized pilot trial. International Journal of Geriatric
Psychiatry, 14, 626–632.
Lyons, R. F., Sullivan, M. J. L., Ritvo, P. G., & Coyne, J. C. (Eds.). (1995).
Relationships in chronic illness and disability. Thousand Oaks, CA:
*Mahler, H. I. M., & Kulik, J. A. (2002). Effects of a videotape information
intervention for spouses on spouse distress and patient recovery from
surgery. Health Psychology, 21, 427–437.
Mahoney, F. I., & Barthel, D. W. (1965). Functional evaluation: The
Barthel Index: A simple index of independence useful in scoring im-
provement in the rehabilitation of the chronically ill. Rehabilitation, 4,
Manne, S. L. (1999). Intrusive thoughts and psychological distress among
cancer patients: The role of spouse avoidance and criticism. Journal of
Consulting and Clinical Psychology, 67, 539–546.
*Marriott, A., Donaldson, C., Terrier, N., & Burns, A. (2000). Effective-
ness of cognitive–behavioural family intervention in reducing the bur-
den of care in carers of patients with Alzheimer’s disease. British
Journal of Psychiatry, 176, 557–562.
Martire, L. M., & Schulz, R. (2001). Informal caregiving to older adults:
Health effects of providing and receiving care. In A. Baum, T. Reven-
son, & J. Singer (Eds.), Handbook of health psychology (pp. 477–493).
Mahwah, NJ: Erlbaum.
Martire, L. M., Stephens, M. A. P., Druley, J. A., & Wojno, W. C. (2002).
Negative reactions to received spousal care: Predictors and conse-
quences of miscarried support. Health Psychology, 21, 167–176.
*McCurry, S. M., Logsdon, R. G., Vitiello, M. V., & Teri, L. (1998).
Successful behavioral treatment for reported sleep problems in elderly
caregivers of dementia patients: A controlled study. Journal of Geron-
tology, 53B, P122–P129.
Meyer, T. J., & Mark, M. M. (1995). Effects of psychosocial interventions
with adult cancer patients: A meta-analysis of randomized experiments.
Health Psychology, 14, 101–108.
*Mittelman, M. S. (2000). Nonpharmacologic management and treat-
ment: Effect of support and counseling on caregivers of patients with
Alzheimer’s disease. International Psychogeriatrics, 12(Suppl. 1),
*Mittelman, M. S., Ferris, S. H., Shulman, E., Steinberg, G., Ambinder, A.,
Mackell, J. A., et al. (1995). A comprehensive support program: Effect
on depression in spouse-caregivers of AD patients. Gerontologist, 35,
*Mittelman, M. S., Ferris, S. H., Steinberg, G., Shulman, E., Mackell, J. A.,
Ambinder, A., et al. (1993). An intervention that delays institutionaliza-
tion of Alzheimer’s disease patients: Treatment of spouse-caregivers.
Gerontologist, 33, 730–740.
*Mohide, E. A., Pringle, D. M., Streiner, D. L., Gilbert, J. R., Muir, G., &
Tew, M. (1990). A randomized trial of family caregiver support in the
home management of dementia. Journal of the American Geriatrics
Society, 38, 446–454.
*Montgomery, R. J. V., & Borgatta, E. F. (1989). The effects of alternative
support strategies on family caregiving. Gerontologist, 29, 457–464.
*Moore, J. E., & Chaney, E. F. (1985). Outpatient group treatment of
chronic pain: Effects of spouse involvement. Journal of Consulting and
Clinical Psychology, 53, 326–334.
*Morisky, D. E., Levine, D. M., Green, L. W., Shapiro, S., Russell, R. P.,
& Smith, C. R. (1983). Five-year blood pressure control and mortality
following health education for hypertensive patients. American Journal
of Public Health, 73, 153–162.
*Newcomer, R., Yordi, C., DuNah, R., Fox, P., & Wilkinson, A. (1999).
Effects of the Medicare Alzheimer’s Disease Demonstration on care-
giver burden and depression. Health Services Research, 34, 669–689.
Ory, M. G., Hoffman, R. R., III, Yee, J. L., Tennstedt, S., & Schulz, R.
(1999). Prevalence and impact of caregiving: A detailed comparison
between dementia and non-dementia caregivers. Gerontologist, 39, 177–
*Ostwald, S. W., Hepburn, K. W., Caron, W., Burns, T., & Mantell, R.
(1999). Reducing caregiver burden: A randomized psychoeducational
intervention for caregivers of persons with dementia. Gerontologist, 39,
Parmelee, P. A. (1983). Spouse versus other family caregivers: Psycho-
logical impact on impaired aged. American Journal of Community
Psychology, 11, 337–349.
Payne, B., & Norfleet, M. A. (1986). Chronic pain and the family: A
review. Pain, 26, 1–22.
Penninx, B. W., Guralnik, J. M., Pahor, M., Ferrucci, L., Cerhan, J. R.,
Wallace, R. B., et al. (1998). Chronically depressed mood and cancer
risk in older persons. Journal of the National Cancer Institute, 90,
Pusey, H., & Richards, D. (2001). A systematic review of the effectiveness
of psychosocial interventions for carers of people with dementia. Aging
and Mental Health, 5, 107–119.
IS IT BENEFICIAL TO INVOLVE A FAMILY MEMBER?
*Quayhagen, M. P., & Quayhagen, M. (1989). Differential effects of
family-based strategies on Alzheimer’s disease. Gerontologist, 29, 150–
*Quayhagen, M. P., Quayhagen, M., Corbeil, R. R., Hendrix, R. C.,
Jackson, J. E., Snyder, L., et al. (2000). Coping with dementia: Evalu-
ation of four nonpharmacologic interventions. International Psychoge-
riatrics, 12, 249–265.
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for
research in the general population. Applied Psychological Measurement,
*Radojevic, V., Nicassio, P. M., & Weisman, M. H. (1992). Behavioral
intervention with and without family support for rheumatoid arthritis.
Behavior Therapy, 23, 13–30.
Rankin-Esquer, L. A., Deeter, A. K., & Taylor, C. B. (2000). Coronary
heart disease and couples. In K. B. Schmaling & T. G. Sher (Eds.), The
psychology of couples and illness: Theory, research, and practice (pp.
43–70). Washington, DC: American Psychological Association.
*Rich, M. W., Beckham, V., Wittenberg, C., Leven, C. L., Freedland,
K. E., & Carney, R. M. (1995). A multidisciplinary intervention to
prevent the readmission of elderly patients with congestive heart failure.
New England Journal of Medicine, 333, 1190–1195.
*Roberts, J., Browne, G., Milne, C., Spooner, L., Gafni, A., Drummond-
Young, M., et al. (1999). Problem-solving counseling for caregivers of
the cognitively impaired: Effective for whom? Nursing Research, 48,
*Robinson, K. M. (1988). A social skills training program for adult
caregivers. Advances in Nursing Sciences, 10, 59–72.
*Robinson, K., & Yates, K. (1994). Effects of two caregiver-training
programs on burden and attitude toward help. Archives of Psychiatric
Nursing, 8, 312–319.
Rosenthal, R. (1991). Meta-analytic procedures for social research. New-
bury Park, CA: Sage.
*Saarijarvi, S. (1991). A controlled study of couple therapy in chronic low
back pain patients: Effects on marital satisfaction, psychological distress
and health attitudes. Journal of Psychosomatic Research, 35, 265–272.
*Saarijarvi, S., Rytoekoski, U., & Alanen, E. (1991). A controlled study of
couple therapy in chronic low back pain patients: No improvement of
disability. Journal of Psychosomatic Research, 35, 671–677.
Schulz, R., & Beach, S. (1999). Caregiving as a risk factor for mortality:
The Caregiver Health Effects Study. Journal of the American Medical
Association, 282, 2215–2219.
Schulz, R., Draper, R. A., & Rollman, B. L. (2002). Depression as a risk
factor for non-suicide mortality in the elderly. Biological Psychiatry, 52,
Schulz, R., O’Brien, A., Bookwala, J., & Fleissner, K. (1995). Psychiatric
and physical morbidity effects of Alzheimer’s disease caregiving: Prev-
alence, correlates, and causes. Gerontologist, 35, 771–791.
Schulz, R., O’Brien, A., Czaja, S., Ory, M., Norris, R., Martire, L. M., et
al. (2002). Dementia caregiver intervention research: In search of clin-
ical significance. Gerontologist, 42, 589–602.
Schwartz, L., & Ehde, D. M. (2000). Couples and chronic pain. In K. B.
Schmaling & T. G. Sher (Eds.), The psychology of couples and illness:
Theory, research, and practice (pp. 191–216). Washington, DC: Amer-
ican Psychological Association.
*Schwiebert, V. L., & Myers, J. E. (1994). Midlife care givers: Effective-
ness of a psychoeducational intervention for midlife adults with parent-
care responsibilities. Journal of Counseling and Development, 72, 627–
Shadish, W. R., & Haddock, C. K. (1994). Combining estimates of effect
size. In H. Cooper & L. V. Hedges (Eds.), The handbook of research
synthesis (pp. 261–281). New York: Russell Sage Foundation.
*Silliman, R. A., McGarvey, S. T., Raymond, P. M., & Fretwell, M. D.
(1990). The Senior Care Study: Does inpatient interdisciplinary geriatric
assessment help the family caregivers of acutely ill older patients?
Journal of the American Geriatrics Society, 38, 461–466.
Sorensen, S., Pinquart, M., & Duberstein, P. (2002). How effective are
interventions with caregivers: An updated meta-analysis. Gerontologist,
Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for
assessing the quality of marriage and similar dyads. Journal of Marriage
and the Family, 38, 15–28.
Spielberger, C. D., Gorsuch, R. L., & Lushene, R. E. (1970). State-Trait
Anxiety Inventory for Adults (Form X). Palo Alto, CA: Consulting
*Steffen, A. M. (2000). Anger management for dementia caregivers: A
preliminary study using video and telephone interviews. Behavior Ther-
apy, 31, 281–299.
*Stewart, S., Pearson, S., & Horowitz, J. D. (1998). Effects of a home-
based intervention among patients with congestive heart failure dis-
charged from acute hospital care. Archives of Internal Medicine, 158,
*Sutcliffe, C., & Larner, S. (1988). Counselling carers of the elderly at
home: A preliminary study. British Journal of Clinical Psychology, 27,
*Teri, L., Logsdon, R. G., Uomoto, J., & McCurry, S. M. (1997). Behav-
ioral treatment of depression in dementia patients: A controlled clinical
trial. Journal of Gerontology, 52B, P159–P166.
Teri, L., Logsdon, R. G., Uomoto, J., Zarit, S., & Vitaliano, P. (1992).
Assessment of behavioral problems in dementia: The Revised Memory
and Behavior Problems Checklist. Psychology and Aging, 7, 622–631.
*Thompson, D. R., & Meddis, R. (1990). A prospective evaluation of
in-hospital counselling for first time myocardial infarction men. Journal
of Psychosomatic Research, 34, 237–248.
*Thompson, D. R., & Meddis, R. (1990). Wives’ responses to counselling
early after myocardial infarction. Journal of Psychosomatic Research,
*Toseland, R. W., Blanchard, C. G., & McCallion, P. (1995). A problem
solving intervention of caregivers of cancer patients. Social Science and
Medicine, 40, 517–528.
*Toseland, R. W., Labrecque, M. S., Goebel, S. T., & Whitney, M. H.
(1992). An evaluation of a group program for spouses of frail elderly
veterans. Gerontologist, 32, 382–390.
*Toseland, R. W., McCallion, P., Smith, T., Huck, S., Bourgeois, P., &
Garstka, T. A. (2001). Health education groups for caregivers in an
HMO. Journal of Clinical Psychology, 57, 551–570.
Toseland, R. W., & Rossiter, C. M. (1989). Group interventions to support
family caregivers: A review and analysis. Gerontologist, 29, 438–448.
*Toseland, R. W., Rossiter, C. M., & Labrecque, M. A. (1989). The
effectiveness of peer-led and professionally led groups to support family
caregivers. Gerontologist, 29, 465–471.
*Toseland, R. W., & Smith, G. C. (1990). Effectiveness of individual
counseling by professional and peer helpers for family caregivers of the
elderly. Psychology and Aging, 5, 256–263.
Tower, R. B., & Kasl, S. V. (1996). Gender, marital closeness, and
depressive symptoms in elderly couples. Journal of Gerontology, 51,
Turk, D. C., & Kerns, R. D. (Eds.). (1985). Health, illness and families: A
life span perspective. New York: Wiley.
*Turner, J. A., Clancy, S., McQuade, K. J., & Cardenas, D. D. (1990).
Effectiveness of behavioral therapy for chronic low back pain: A com-
ponent analysis. Journal of Consulting and Clinical Psychology, 58,
*van den Heuvel, E. T. P., De Witte, L. P., Nooyen-Haazen, I., Sanderman,
R., & Jong, B. M. (2000). Short-term effects of a group support program
and an individual support program for caregivers of stroke patients.
Patient Education and Counseling, 40, 109–120.
*van Elderen, T., Maes, S., Seegers, G., Kragten, H., & Wely, L. R. (1994).
MARTIRE, LUSTIG, SCHULZ, MILLER, AND HELGESON
Effects of a post-hospitalization group health education programme for
patients with coronary heart disease. Psychology and Health, 9, 317–
*Weuve, J. L., Boult, C., & Morishita, L. (2000). The effects of outpatient
geriatric evaluation and management on caregiver burden. Gerontolo-
gist, 40, 429–436.
Wright, L. K., Clipp, E. C., & George, L. K. (1993). Health consequences
of caregiver stress. Medicine, Exercise, Nutrition and Health, 2, 181–
*Wright, L. K., Litaker, M., Laraia, M. T., & DeAndrade, S. (2001).
Continuum of care for Alzheimer’s disease: A nurse education and
counseling program. Issues in Mental Health Nursing, 22, 231–252.
*Zarit, S. H., Anthony, C. R., & Boutselis, M. (1987). Interventions with
caregivers of dementia patients: Comparison of two approaches. Psy-
chology and Aging, 2, 225–232.
*Zarit, S. H., & Zarit, J. M. (1982). Families under stress: Interventions for
caregivers of senile dementia patients. Psychotherapy: Theory, Research
and Practice, 19, 461–471.
Zarit, S. H., & Zarit, J. M. (1990). The Memory and Behaviour Problems
Checklist and the Burden Interview. University Park: Pennsylvania State
University Gerontology Center.
Zautra, A. J., & Manne, S. L. (1992). Coping with rheumatoid arthritis: A
review of a decade of research. Annals of Behavioral Medicine, 14,
New Editors Appointed, 2006–2011
The Publications and Communications Board of the American Psychological Association an-
nounces the appointment of seven new editors for 6-year terms beginning in 2006. As of January
1, 2005, manuscripts should be directed as follows:
• Experimental and Clinical Psychopharmacology (www.apa.org/journals/pha.html), Nancy K.
Mello, PhD, McLean Hospital, Massachusetts General Hospital, Harvard Medical School, 115
Mill Street, Belmont, MA 02478-9106.
• Journal of Abnormal Psychology (www.apa.org/journals/abn.html), David Watson, PhD, De-
partment of Psychology, University of Iowa, Iowa City, IA 52242-1407.
• Journal of Comparative Psychology (www.apa.org/journals/com.html), Gordon M. Burghardt,
PhD, Department of Psychology or Department of Ecology & Evolutionary Biology, University
of Tennessee, Knoxville, TN 37996.
• Journal of Counseling Psychology (www.apa.org/journals/cou.html), Brent S. Mallinckrodt,
PhD, Department of Educational, School, and Counseling Psychology, 16 Hill Hall, University
of Missouri, Columbia, MO 65211.
• Journal of Experimental Psychology: Human Perception and Performance (www.apa.org/
journals/xhp.html), Glyn W. Humphreys, PhD, Behavioural Brain Sciences Centre, School of
Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom.
• Journal of Personality and Social Psychology: Attitudes and Social Cognition section
(www.apa.org/journals/psp.html), Charles M. Judd, PhD, Department of Psychology, Univer-
sity of Colorado, Boulder, CO 80309-0345.
• Rehabilitation Psychology (www.apa.org/journals/rep.html), Timothy R. Elliott, PhD, Depart-
ment of Psychology, 415 Campbell Hall, 1300 University Boulevard, University of Alabama,
Birmingham, AL 35294-1170.
Electronic submission: As of January 1, 2005, authors are expected to submit manuscripts
electronically through the journal’s Manuscript Submission Portal (see the Web site listed above
with each journal title).
Manuscript submission patterns make the precise date of completion of the 2005 volumes uncertain.
Current editors, Warren K. Bickel, PhD, Timothy B. Baker, PhD, Meredith J. West, PhD, Jo-Ida C.
Hansen, PhD, David A. Rosenbaum, PhD, Patricia G. Devine, PhD, and Bruce Caplan, PhD,
respectively, will receive and consider manuscripts through December 31, 2004. Should 2005
volumes be completed before that date, manuscripts will be redirected to the new editors for
consideration in 2006 volumes.
IS IT BENEFICIAL TO INVOLVE A FAMILY MEMBER?